Monday, March 30, 2020

Reason vs Science and COVID-19

That which is reasonable isn't necessarily scientific, and is frequently untrue. 

Should America be locked down? More and more reasonable voices say no. And they have their reasonable advocates. The problem is that reason in this case isn't scientific, just as a reasonable hypothesis can be totally false.

For example. Given all we know about the relationship between disease and death we can reasonably say that there are usually multiple causes of death, and frequently multiple diseases involved. This leads to the reasonable hypothesis that the COVID-19 disease caused by the corona virus may not be any more fatal than the seasonal flu; that it is simply one of many co-morbidities involved in the deaths of those who have it. And it reasonably follows that drastic steps taken to halt its spread are ill conceived. 

To move beyond reason to science we would now need to test this hypothesis. The obvious test is to expose a large population to the corona virus and then see if mortality rates are significantly above normal. Of course we would need to control for other factors as well: things such as available health care interventions, overall health of the population involved, and of course population density, climate, and patterns of social interaction. But it could be done.

The problem, and this has always been the problem for epidemiology, is that the only definitive experiments must be run in real time on real humans. And that means that the if the reasonable hypothesis turns out to be wrong a lot of real people die unnecessarily. This is why when human lives are at stake epidemiologists recommend public policy based on the worst-case reasonable hypothesis. In this case the hypothesis that a disease such is COVID-19 is likely to be the leading cause of death, increasing greatly the risk of death, and not merely being on of many factors. 

And we've been here before. Stringent measures to reduce air pollution, the banning of smoking indoors, the removal of potential carcinogens from food, the imposition of mandatory vaccinations, requiring seat belts and airbags in autos, and a thousand others public policies flew in the face of reasonable hypothesis concerning causes of death from smoking, cancer, disease, and auto accidents. Whole industries labored to produce reasonable hypothesis to maintain the status quo. And these policies that we now take for granted were the implementation of the worst case hypothesis long before full data was available. They were, quite frankly, experiments on human populations. They happen to be experiments that have uniformly shown that their hypothetical basis was accurate. 

But they haven't just saved lives. They have been the basis for a robust economy. Because there is nothing more valuable to an economy than human lives. Only humans, when they have enough, immediately begin to imagine new things to want. And that includes humans "sheltering in place." Like our deep ancestors hunkered down in a cave against lions and the cold we stand apart from our primate cousins in that we want entertainment and we love to create. From chalk art on sidewalks to YouTube videos to home-knitted sweaters to electronic concertos (even now being written) to cures for diseases we haven't stopped wanting or creating just because we're currently in the cave. 

And what that means, or so I reasonably hypothesize, is that what we'll see in the future isn't a ruined economy, but a changed economy. We are learning to want different kinds of more than we already have. And we'll discover some things we thought we desperately wanted are not all that important. But of course the results aren't in from the only experiment that can test my ideas.

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